Phoenix College - Exam Site Information for Candidates The Commission on Dental Competency Assessments (CDCA exam)
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Phoenix College
Exam Site Information for Candidates
The Commission on Dental Competency
Assessments (CDCA exam)
Phoenix College Center for Excellence in
Healthcare Education
Department of Dental Programs
3144 N. 7th Avenue
(602) 285-7331
Exam Site Information for Candidates
2021 CDCA Dental Hygiene Examination
Table of Contents
1. School Facility and Services
• Clinic Address, Building Access and Hours
• Parking
• Security and Emergency Services
• ATM Machine
• Food Services Onsite
2. Preparing for the Exam
• Patient Screening
• Radiographs
• Administration of Local Anesthetic – Practitioner Availability
• Dental Operatory Units
• Equipment, Instruments and Expendable Materials
• Sterilization Services
3. During the Exam
• Infection Control (Surface Asepsis)
• Medical Emergencies and Equipment
4. Travel and Accommodation Information
• Airport Information
• Ground Transportation
• Hotel Accommodation
5. Appendices
• Campus Map
• Clinic Floor Plan
• Expendable Dental Materials Lists
• Supply Purchase/ Equipment Rental policy and form
Phoenix College Page 2 of 18
1. School Facility and Services
• Location, Building Access and Hours: Phoenix College Dental Clinic is located off the
main campus on the corner of 7th Avenue and Flower Street. Flower Street is south of
Osborn Road. The dental clinic is located on the second floor above the covered parking.
The dental clinic entrance is on the second floor and can be reached by parking lot
elevator, adjacent building elevator and stairs leading to the second floor bridge. Follow
the directional signs to the clinic entrance. The address is 3144 N. 7th Avenue, Phoenix,
AZ 85013. The Phoenix College Healthcare Center campus map is available in the Map
section of the test site information packet. The building open 6:00am-6:00pm daily for
duration of exam
• School coordinator, Brandi Mazzarella can be reached at (602) 285-7331 for inquiries
regarding school, equipment, and clinic information.
• Parking: Candidates and their patients are welcomed to park in unmarked parking
spaces. Patient parking is designated. Patients are welcome to park in the unmarked
parking once the designated patient parking is full. There is no additional fee for parking.
• Security and Emergency Services:
At Phoenix College, the safety and well-being of our students, faculty, and staff is of
primary importance. In the event of an emergency or crisis situation, the Public Safety
Department will make timely warnings to the campus community.
IMMEDIATELY CALL 9-1-1 IN ANY LIFE-THREATENING SITUATION
General Emergency:
1. Notify District Public Safety at 480-784-0911, and then notify 911 (if necessary).
2. If evacuation is required, pull fire alarm.
3. Follow normal evacuation route. Follow alternate route if normal route is too dangerous.
4. Missing personnel and last known location will be relayed to Public Safety.
An emergency is any immediate threat to life and/or property that requires immediate
response from police, fire, or ambulance personnel. Your judgment often determines
whether an incident is an emergency. If you consider a situation to be an emergency,
then it is an emergency and the procedures in this booklet should be followed. If in doubt,
err on the side of safety!
Fire:
Campus community members may deal with small, extinguishable fires as long as personal
safety is not compromised and they are trained in the use of fire extinguishers. However,
always remember that personal safety should be your first concern. Never place yourself in a
position where the fire is between you and the exit.
• Notify District Public Safety at 480-784-0911 and then call 9-1-1.
• Activate fire alarm as you leave the building.
• Alert all occupants in your area.
• Evacuate to an assembly area. Follow normal evacuation drill route. Follow alternate route
Phoenix College Page 3 of 18
if normal route is too dangerous.
• Assist those requiring help to the exterior or to an area of rescue assistance.
• Take only your car keys and purse with you.
• Shut all doors behind you as you go. Closed doors tend to slow the spread of fire, smoke,
and water.
• DO NOT use elevators.
• DO NOT allow the fire to come between you and the exit.
• Notify District Public Safety at 480-784-0911 or 9-1-1 from a safe location. Watch for the
responding officer and provide information on the fire location and extent.
• No one may re-enter buildings until all buildings are declared safe by fire/police.
• Public Safety notifies employees/students when situation is clear and normal operations
may resume.
• Report persons with disabilities to Public Safety for assistance.
Emergency evacuation of people requiring assistance from multi-story buildings
• Always ASK a person requiring assistance how you can help BEFORE attempting any
rescue technique or giving assistance; ask how they can best be assisted or moved, and if
there are any special considerations, or items that need to come with them.
• Immediately notify District Public Safety at 480-784-0911 or 9-1-1 that there is a person(s)
with a disability that requires assistance
Procedure for Reporting a Medical Emergency:
A. The person who discovers the emergency will verbally alert a CDCA official
B. The CDCA official will assist by:
1. Delivering the Medical Emergency Cart (contains oxygen and emergency kit)
2. Alerting the front desk to call 911 and District Public Safety at 4-0911
C. Meanwhile, the person who discovered the emergency will begin a primary
assessment:
1. Check for responsiveness, airway, breathing, and pulse. IF there is
no breathing and/or pulse, artificial respiration or CPR is started
immediately.
2. If there is breathing and pulse, a secondary survey should be started
including review of medical history and recording of blood pressure and
pulse every
5 minutes.
3. Oxygen support should be instituted if any signs of lack of oxygen are noted.
D. CDCA official summoned will:
1. Immediately go to the emergency location
2. Assess client and assume responsibility for emergency treatment until
someone with more training has arrived and all pertinent information
has been relayed.
E. Following the emergency:
1. If 911 is notified, an Incident Report must be filed with Phoenix College Campus
Safety. (602-285-7254)
2. The emergency must be documented in the patient’s record.
Evacuation Plan: Posted throughout the building near the fire pulls and exits
Phoenix College Page 4 of 18
Instructor stations located in the dental clinic contain quick reference sheets for emergency
protocol and phones.
Phoenix College Safety
(602) 285-7254
• ATM Machine: There is no ATM available on campus. The location of nearby ATMs
are:
Chase, 2901 N 7th Ave, Phoenix, AZ 85013
U.S. Bank, 520 West Osborn Road, (located inside Safeway Grocery Store) Phoenix, AZ
85013
• Food Services Onsite: There are no food service companies on campus. There are two
vending machines located on the second floor near the elevators. One vending machine
contains beverages, and the other contains snacks.
Restaurants near Phoenix College
Applebee’s (602) 266-3330
2 E. Camelback Road, Phoenix, AZ 85012
(Northeast corner of Central Avenue and Camelback Road)
Burger Factory
702 W. Osborn Road, Phoenix, AZ 85013 (602) 263-0807
(Northwest corner of 7th Avenue and Osborn Road)
First Watch
61 West Thomas Road, Phoenix, AZ 85013 (602) 265-2092
(South side of Thomas Road at 2nd Avenue)
The Original Hamburger Works
2801 North 15th Avenue, Phoenix, AZ 85007 (602) 263-8693
(15th Avenue south of Thomas Road)
Kentucky Fried Chicken
2902 North 7th Avenue, Phoenix, AZ 85013 (602) 234-8346
(7th Avenue north of Thomas Road)
La Pinata
3330 North 19th Avenue (602) 279-1763
(Southwest corner of 19th Avenue and Osborn Road)
Mi Patio
3347 North 7th Avenue, Phoenix, AZ 85015 (602) 277-4831
(Southeast corner of 7th Avenue and Osborn Road)
Phoenix College Page 5 of 18
Mu Shu Asian Grill
1502 West Thomas Road, Phoenix, AZ 85013 (602) 277-9867
(North side of Thomas Road at 15th Avenue)
Peter Piper Pizza (602) 266-0040
3403 N. 7th Avenue, Phoenix, AZ
(Northeast corner of 7th Avenue and Osborn Road)
Sacks Art of Sandwicheries
231 West Thomas Road, Phoenix, AZ 85013 (602) 604-9661
(South side of Thomas Road at 2nd Avenue)
Monday- Saturday 8:00 AM - 3:00 PM
Subway
3413 North 7th Avenue, Phoenix, AZ 85013 (602) 274-5074
(Northeast corner of 7th Avenue and Osborn Road)
Taco Bell
4035 North 7th Avenue, Phoenix, AZ 85013 (602) 266-2819
(7th Avenue south of Indian School Road)
Monday - Friday 7:00 AM - 12:00 AM
2. Preparing for the Hygiene Exam
• Patient Screening: Candidates who are in need of patient screening are to make
arrangements with the school coordinator. Please call the school coordinator at (602)
285-7331. Screening instruments will be available for rental. Please see rental policy
section and supply rental form. Phoenix College will provide dates prior to the CDCA
examination for patient screening. The dates posted are not available on a walk-in
basis. Candidates must receive permission from school coordinator for patient
screenings prior to arriving. It will be the candidate’s responsibility to contact the school
coordinator and make arrangements before the posted dates.
2021 Available Screening Dates:
NA- Manikin Exam only
• Radiographs: The completion of patient’s radiographs prior to the CDCA scheduled
examination dates is recommended. Phoenix College dental clinic is equipped with digital
radiograph equipment and Dexis program. The use of the radiograph equipment, PSP
plates, and XCP/Rinn positioning devices will be available for candidates who are in need
of retaking a radiographs. Candidates will be responsible in taking their own radiographs
and have access during their scheduled exam. Candidates are responsible in placing,
exposing, processing and mounting radiographs. The floor assistant will print radiographs.
The dental clinic time allocated for patient screening can be utilized for taking radiograph
on backup patients. Candidate taking the CDCA exam will have precedence over
radiograph request for backup patients during examination dates. Please inform school
coordinator of need for taking radiographs during candidates’ orientation or by phone at
(602) 285-7331.
Phoenix College Page 6 of 18
• Administration of Local Anesthetic:
Practitioner(s) from the school is NOT AVAILABLE to administer local anesthesia to
Candidate Patients.
• Equipment, Instruments and Expendable Dental Materials: Refer to the respective
CDCA Candidate Guide for a list of materials and armamentarium that the Candidate must
provide.
A. Handpiece and Prophy Angle Hookups:
Slow speed hand pieces and disposable prophy angles are supplied at no cost for
candidates. Midwest RDH and Midwest Rhino with straight attachment are the slow
hand pieces available. Slow speed hand pieces are available with the expendable
materials supplied and sterilized after each use. The dental chairs in clinic contain
four holes dental hand piece hose with a connector for candidates who choose to
bring their slow speed hand piece.
B. Sonic/Ultrasonic Devices: CDCA allows the use of sonic/ultrasonic devices as an adjunct
to calculus removal. Each operatory contains a Dentsply Cavitron ultrasonic scaler unit for
30K ultrasonic inserts. Autoclavable Cavitron Steri-Mate detachable hand pieces are
supplied and sterilized after each use. The ultrasonic inserts are not included. Ultrasonic
inserts will be available for rent. Rental supply policy and form will be available during the
CDCA exam dates and can be viewed in the Appendices of this packet. Candidates are
welcome to bring in their own table top ultrasonic scaler. Three-prong outlets and dental
water supply hose with quick connect adaptor are accessible within the free standing unit.
C. Air/Water Syringe Tips: Are syringe tips disposable and supplied with expendable
materials. Please review expendable dental material list in the appendix section.
D. Blood Pressure Cuffs and Stethoscopes: A blood pressure cuff and stethoscope
will be located with emergency supply cart for candidates. As a courtesy to fellow
Phoenix College Page 7 of 18
candidates, return blood pressure cuff and stethoscope after use.
E. Expendable Materials: Expendable dental materials supplied by the school are noted in
Appendix A.
• Sterilization Services: Please place instruments in sterilization bags clearly labeled with
your candidate number. Do not seal the sterilization bag if you want your instruments
ultrasonically cleaned. Seal the sterilization bag if you do not want them ultrasonically
cleaned. A cart marked “dirty instruments” will be designated for candidates to place
autoclave bags with contaminated instruments for sterilization services.
Sterilized instruments can be picked up at the front desk. Once the examinations begin,
instruments will be attended to every two hours to allow proper disinfecting, sterilization
time and drying. Instruments received in the late morning will be available in the afternoon.
Instruments received at the end of the day can be picked up the following exam day upon
dental clinic opening. Candidates scheduled on the last day in the afternoon will not be
guaranteed to have sterilized instruments by end of day. Candidates are welcome to return
when the dental clinic hours resume for the dental program summer session. Sterilization
will be closed at 5:00 pm daily during the exam scheduled dates. Delays may occur with
equipment processing, addressing CDCA exam needs, and prioritizing candidates with
retakes.
The floor assistant and Phoenix College staff will work to the best of their ability with
candidates who will be retaking an exam on site to have instruments sterilized.
Unsterilized instruments are considered contaminated items. Candidates choosing not to
have instruments sterilized will be required to place items in a plastic bag for carrying out
of the dental clinic. Autoclave bags, autoclave tape, plastic bags, and gloves will be
provided. Please do not place items in unsterilized autoclave bag without a plastic bag
covering directly into personal belongings or hand unsterilized autoclave bag with
contaminated items to floor assistant or staff.
3. Preparing for the Local Anesthesia Exam
• Equipment, Instruments and Expendable Dental Materials:
A. Air/Water Syringe Tips: Syringe tips are disposable and supplied with expendable
materials. Please review expendable dental material list in the appendix section.
B. Expendable Materials: Expendable dental materials supplied by the school are noted in
Appendix B.
• Sterilization Services: Please place instruments in sterilization bags clearly labeled with
your name or candidate number. Do not seal the sterilization bag if you want your
instruments ultrasonically cleaned. Seal the sterilization bag if you do not want them
ultrasonically cleaned. A cart marked “dirty instruments” will be designated for candidates
to place autoclave bags with contaminated instruments for sterilization services.
The sterilized instruments can be picked up at the front desk. Once the examinations begin,
instruments will be attended to every two hours to allow proper disinfecting, sterilization
time and drying. Instruments received at the end of the morning session will be available
in the afternoon. Instruments received at the end of the day can be picked up the following
exam day upon dental clinic opening. Candidates scheduled on the last appointed time in
Phoenix College Page 8 of 18
the afternoon will not be guaranteed to have sterilized instruments by the end of the day.
Candidates are welcome to return when the dental clinic hours resume for the dental
program summer session. Sterilization will be closed at 5:00 pm daily during the exam
scheduled dates. Delays may occur with equipment processing, addressing CDCA exam
needs, and prioritizing candidates with retakes.
Phoenix College staff will work to the best of their ability with candidates who will be retaking
an exam on site to have instruments sterilized.
Unsterilized instruments are considered contaminated items. Candidates choosing not to
have instruments sterilized will be required to place items in a plastic bag for carrying out
of the dental clinic. Autoclave bags, autoclave tape, plastic bags, and gloves will be
provided. Please do not place items in unsterilized autoclave bag without a plastic bag
covering directly into personal belongings or hand unsterilized autoclave bag with
contaminated items to floor assistant or staff.
4. During the Clinical Exam
• Dental Operatory Units: There are 20 A-dec Radius operatories in the dental hygiene
clinic consisting of a cart, dental chair, overhead light and radiograph view box. The
operatories are equipped with self-contained water systems that will be maintained by the
floor assistant.
• Infection Control (Surface Asepsis):
Infection Control Protocol:
Universal Precautions and Standard Personal Protective Equipment are practiced in
the dental clinic. This consist of the use of a lab coat, gloves, masks, OSHA
acceptable protective eyewear, closed-toe shoes and socks that cover ankles.
Unit Disinfection:
Flush water lines for 30 seconds before setting up operatory. Certol International
ProSpray™ disinfectant wipes will be available for use near each unit. Wipe and
maintain contact with the surface being cleaned for 15 seconds. Disinfect the entire
unit including handpiece lines, hoses, air/water syringe, HVE, saliva ejector, working
surfaces, Cavitron unit, view box, light handles and switch to complete cleaning
Phoenix College Page 9 of 18
phase. Once completed, use another disinfectant wipe to wet all surfaces a second
time to complete disinfection phase. According to the manufacture, Follow CDC
recommendations for surface disinfection. Clean first, then disinfect. ProSpray wipes
are effective for both steps. (1) Remove and unfold one or more towelettes as needed
to thoroughly clean surfaces. (2) Use sufficient wipes for the area or equipment.
Studies show that over use of one wipe over too large an area will spread
contamination. (3) Discard towelettes used for cleaning. (4) Using fresh towelette(s),
reapply for 3 minute contact time. Use gauze and soapy water to clean the operator
and patient chairs, and the lens cover of the dental light when visibly soiled. Visibly
soiled items include blood and debris. Do not use disinfectant on the lens cover, it
will cause clouding.
Barrier Wrapping of Unit:
After proper disinfection of unit, surfaces that may be contacted during patient
treatment must be wrapped with plastic film. You will be provided with plastic dental
chair covers and barrier sleeves. Chair covers can be used to cover the patient chair,
dental unit, Cavitron, and counter surfaces. Plastic sleeves will be provided to cover
the attachments and cords of the handpiece, Cavitron, HVE, air/water syringe and
light handles.
A. Hazardous Waste Disposal:
o Hygiene: Recommended that a small biohazard bag is attached
to your unit while treating your patient
o Local Anesthesia: Procedure for disposal will be recommended
to follow instructions provided if of blood/saliva-soaked waste
occurs.
Small biohazard bag will be available. Please discard all blood or saliva soaked
disposables into this bag. After treatment, tape the bag
closed and place in the biohazard receptacle located in the
main clinic island with expendable dental materials. Used
plastic wrapping and patient disposables that are not
biohazardous can be placed in the trash containers located
at each handwashing island.
B. Sharps Disposal:
Phoenix College follows OSHA standards in sharps disposal.
Sharps are objects that can penetrate a worker’s skin, such as needles, scalpels, broken
glass, capillary tubes and the exposed ends of dental wires. If blood or other potentially
infectious materials (OPIM), as defined in the OSHA Bloodborne Pathogens standard (29
CFR 1910.1030), are present or may be present on the sharp, it is a contaminated sharp
and appropriate personal protective equipment must be worn. Indicate location of sharps
containers
(https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact02.pdf). In
addition to the OSHA provided sharp reference the dental clinic requires
anesthetic cartridges and broken instruments. A sharp container is located
in each operatory. Larger items such as broken instruments can be placed
in the biohazard trash receptacle located in the main clinic island with
expendable dental materials. A photograph with the sharp container in the
operatory can be viewed in the Dental Operatory Unit section of this packet.
Phoenix College Page 10 of 18• Emergency Medical Equipment:
Location of Emergency Equipment
A.The Portable Medical Emergency Cart is located on the North West side of the clinic
near the exit.
B.The Automatic External Defibrillator Unit is located on the North West wall of the dental
clinic.
C. Four Eyewash Stations are available:
1- located the east side of the dental clinic
1- located on the north side of the dental clinic
1- on the west side of the dental clinic
1- inside the Sterilization Room (HE A232)
5. Travel and Accommodation Information
• Airport Information: Phoenix Sky Harbor International Airport is located approximately
6.7 miles away from Phoenix College Dental Clinic.
Website: https://www.skyharbor.com/
• Ground Transportation: List airport shuttle service, public transportation
Request Ride Services:
Lyft - https://www.lyft.com/signup
Uber – https://www.uber.com/ride/
Shuttle Services:
Arizona Shuttle (Shuttle) http://www.arizonashuttle.com/ 1-800-888-2749
Super Shuttle (Shuttle/Car/SUV) https://www.supershuttle.com/ 1-800-258-3826
Go Airport Shuttles (Shuttle/Sedan/SUV) https://goairportshuttle.com/ 1-844-787-1670
Taxi Services &Phone Numbers:
Apache Taxi (480) 804-1000
Taxi Phoenix (480) 616-0104
Taxi Surprise (480) 616-0105
Checker/Yellow (602) 252-5252
Discount Cab (602) 200-2000
Community Cab (480) 644-1000
Yellow Cab (480) 888-8888
Apache Taxi (480) 804-1000
AAA/Yellow Cab (480) 888-8888
Phoenix College Page 11 of 18Mayflower Cab (602) 955-1355
Budget Airport Transportation (602) 638-1330
• Hotel Accommodations: Near Phoenix College
The Clarendon Hotel & Spa
401 W. Clarendon Avenue, Phoenix, AZ 85013
1-800-916-4339
http://www.goclarendon.com/
Embassy Suites
2333 E. Thomas Road, Phoenix, AZ 85016
(602) 957-1910
http://embassysuites3.hilton.com/en/hotels/arizona/embassy-suites-phoenix-airport-at-
24th-street-PHXTHES/index.html
Hilton Garden Inn Phoenix Midtown
4000 N. Central Avenue, Phoenix, AZ 85012
(602) 279-9811
http://hiltongardeninn3.hilton.com/en/hotels/arizona/hilton-garden-inn-phoenix-midtown-
PHXMDGI/index.html
Hilton Garden Inn Phoenix Downtown
15 East Monroe Street, Phoenix, Arizona, 85004
(602) 343-0006
http://hiltongardeninn3.hilton.com/en/hotels/arizona/hilton-garden-inn-phoenix-
downtown-PHXDOGI/index.html
Hilton Suites
10 E. Thomas Road, Phoenix, AZ 85012
(602) 222-1111
http://www3.hilton.com/en/hotels/arizona/hilton-phoenix-suites-PHXPPHS/index.html
Ramada Phoenix
212 W. Osborn Road, Phoenix, AZ 85013
1-800-946-5338
http://www.holidayinn.com/hotels/us/en/phoenix/phxos/hoteldetail
Quality Inn
202 E. McDowell Road, Phoenix, AZ 85004
(602) 528-9100
http://www.hotelsavings.com/booking/1034008
Wyndham Garden Phoenix Midtown
3600 N. 2nd Avenue, Phoenix, AZ, 85013
http://www.wyndham.com/hotels/arizona/phoenix/wyndham-garden-phoenix-
midtown/hotel-overview?WID=LC:WY:20150901:Rio:Local
Phoenix College Page 12 of 186. Maps
• Campus Map: The newly-renovated Phoenix College Center for Excellence in
Healthcare Education, provides a state-of-the-art learning environment for students and
staff with dynamic spaces housing sophisticated technology and equipment. Features
include dental clinic, massage therapy, and medical office environments, simulation
labs, a large seminar space, student space and flexible classroom spaces. The
Healthcare Building is located south of Osborn Road and north of Thomas Road on 7th
Avenue.
Phoenix College Healthcare Building
Center for Excellence in Healthcare Education
3144 North Seventh Avenue
Phoenix, Arizona 85013
Phoenix College Page 13 of 18Phoenix College Page 14 of 18
• Dental Clinic and Orientation Room Floor Plan: Phoenix College Page 15 of 18
Expendable Dental Materials Appendices
APPENDIX A – Expendable Dental Hygiene Materials List
Provided by Exam Site Host (School)
To be provided in sufficient quantities for all Dental Hygiene Candidates
2x2 gauze squares Cotton-tip applicators Patient bib clips, disposable
Air/water syringe tips Drinking cups Patient napkins/bibs
Antimicrobial mouthwash Face masks Prophy paste
Anesthetic(s) Facial tissue Sanitizing materials
• Local anesthetic(s) with and Gloves Soap
without vasoconstrictors
• Topical anesthetic(s) • Gloves, nonlatex (S,M,L,XL) Standard saliva ejectors
Autoclave bags, small • Overgloves Surface disinfectant
Autoclave bags, medium Headrest covers Tray covers
Autoclave tape Instrument trays, disposable Trash bags
Barrier covers/tape Paper towels
APPENDIX B – Expendable Local Anesthesia Materials List
Provided by Exam Site Host (School)
To be provided in sufficient quantities for all Local Anesthesia Candidates
2x2 gauze squares Cotton-tip applicators Patient bib clips, disposable
Air/water syringe tips Drinking cups Patient napkins/bibs
Antimicrobial mouthwash Face masks Sanitizing materials
Anesthetic(s) Facial tissue Soap
• Local anesthetic(s) with and Gloves Standard saliva ejectors
without vasocontrictors
• Topical anesthetic(s) • Gloves, nonlatex (S,M,L,XL) Surface disinfectant
Autoclave bags, small • Overgloves Tray covers
Autoclave bags, medium Headrest covers Trash bags
Autoclave tape Instrument trays, disposable
Barrier covers/tape Paper towels
Phoenix College Page 16 of 18Supply Purchase/Equipment Rental Form
For Candidates of the CDCA Dental Hygiene/Local Anesthesia Exams
Equipment Rental Policy:
Ultrasonic Insert with 30K tips, aspirating anesthetic syringes, locking hemostats, probes,
mirrors, and 11/12 explorers will be available to rent on the day of your exam. You cannot
reserve equipment in advance; it will be available at the clinic reception desk on the day of
your clinical exam. There is a $5.00 non-refundable fee for use of a syringe, locking
hemostat, probe, mirror, or explorer. There is a $20.00 non-refundable fee for use of the
ultrasonic insert. Check or cash payments are accepted - change is not readily available.
Rental term & agreement:
I understand that the supplies I am renting from Phoenix College MUST be returned and checked
in by the designated Phoenix College representative at the end of my exam.
I am renting the following:
Quantity
___ Cavitron Tip/s ($20.00) Fee $ ___________
___ Aspirating Syringe ($5.00) Fee $ ___________
___ Hemostat ($5.00) Fee $ ___________
___ Probe ($5.00) Fee $ ___________
___ 11/12 Explorer ($5.00) Fee $ ___________
___ Mirror ($5.00) Fee $ ___________
I am purchasing the following:
___ Disposable Gown ($5.00) Fee $ ___________
TOTAL $ ___________
Date ______________________
Name ________________________________________
Address ________________________________________
Phone # _______________________________________
Phoenix College Page 17 of 18Returned ___________ (for office use) Phoenix College Page 18 of 18
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